MODEL*	QUANTITY	COST/EA	EXTENSION
WMA1X6C	_________________	@ $17.00/ea    =	$
WMA2X10C	_________________	@ $25.00/ea    =	$
WMA4X10C	_________________	@ $55.00/ea    =	$
WMA4X24C	_________________	@ $70.00/ea    =	$

TOTAL AMOUNT (less freight and handling) =                                                          $_________________

SOLD TO: _______________________  P.O. #____________________
 _______________________
  _______________________  Date: ____________________
  _______________________
  _______________________  Required by: ______________

SHIP TO: _______________________  Credit Card(V,MC,..):_______
  _______________________  Number:___________________
  _______________________  Exp.Date:__________________
  _______________________  Authorized by:
  _______________________  __________________________
Send Order to:  Aqua-Sorb Products, LLC
                        P.O. Box 100, Higdon, AL 35979
                        Fax  (256)597-3511
                        email:  sales@watermagnet.com

Satisfaction Guaranteed, if used in accordance with instructions.

Packaged: 10/box, 10 boxes/case.   Handling charge of $5.00 will be added under 10/ea.
Prices FOB Higdon, AL                                                  Freight charges will be added.
Shipment by USPS unless otherwise advised by customer.

Terms: Payment with order.
All credit cards accepted.  Government/military cards accepted.
If tax exempt, you must furnish current copy of your tax exemption certificate.
Tether lines and weights are integral to each item.

Prices effective: January 1, 2008

To order by mail or fax, copy this page, fill out the form, and send in.

If you wish to order online, click this link.   ORDER ONLINE